Temple Hill Surgery Also known as (Improved Access Hub)

Updated 29 April 2020

Temple Hill Surgery (Improved Access Hub) is one of seven locations registered by the provider DGS Health Ltd. DGS Health Ltd is an independent limited company which is a GP federation delivering primary healthcare services to patients registered at any of the 28 GP practices in the NHS Dartford, Gravesham and Swanley Clinical Commissioning Group (DGS CCG) area (approximately 275,000 patients). All of the practices are members of the federation. DGS Health Ltd holds a contract with DGS CCG to provide improved access GP services. The organisation also holds contracts with DGS CCG to provide locally a home visiting service and a home visiting service plus (to patients in residential homes). They also provide a wound care service. The CCG contracts for wound care services are currently held by GP practices. However, some practices choose to subcontract the wound care for their patients to the DGS Health Ltd wound care service. They also employ clinical pharmacists who work in local GP surgeries on behalf of some local Primary Care Networks (PCNs).

DGS Health Ltd is an organisation that was established in 2014 by all the local GP practices working together. The current contract for the improved access services was commenced in May 2019, the service having previously been delivered by another organisation with some support from DGS Health Ltd. Appointments must be booked through the patients’ own GP practice. The service provides mainly ‘on the day’ acute GP services for both children and adults with 50% of appointments being bookable one day in advance and 50% on the day of the appointment. GP practices are made aware of which issues or conditions are not ideally suited to be managed in a hub setting. For example, immunisation services are not provided, nor is the issuing of repeat prescriptions, or sick notes.

This report focuses on the inspection of the registered hub location Temple Hill Surgery (Improved Access Hub) which operates the following service: Improved access service.

The registered location Temple Hill Surgery (Improved Access Hub) operates from the following address: Temple Hill Surgery St. Edmunds Road, Dartford, DA1 5ND. It is located within the GP practice Temple Hill Surgery which holds its own registration with CQC for providing core GP services and has been inspected and rated separately by CQC.

DGS Health Ltd operate and administer all the services that they provide from their head office in Northfleet, Kent and also provide services from the following registered locations:

• The Cedars Surgery (Improved Access Hub) 26-28, Swanley Centre, Swanley, BR8 7AH. Provides an improved access service.
• Ivy Bower Surgery (Improved Access Hub), 7 Ivy Bower Close, Greenhithe, Kent, DA9 9NF.

Provides an improved access service.

• The Gateway Medical Practice, Fleet Health Centre, Vale Road, Northfleet, Gravesend, Kent, DA11 8BZ. Provides a wound care service.
• The Oaks Surgery (Improved Access Hub), Nightingale Way, Swanley, Kent, BR8 7UP.

Provides an improved access service and a wound care service.

• White Horse Surgery (Improved Access Hub), Fleet Health Centre, Vale Road, Northfleet, Gravesend, Kent, DA11 8BZ. Provides an improved access service.

DGS Health Ltd have registered the following location but have not yet provided services there:

• Swanscombe Health Centre (Improved Access Hub), Southfleet Road, Swanscombe, Kent, DA10 0BF.

All DGS Health Ltd hub locations are registered to provide the following regulated activities:

• Diagnostic and screening procedures.
• Treatment of disease, disorder or injury.

All these locations were visited during this inspection but are the subject of separate reports.

DGS Health Ltd hosts the telephone call and administrative centres for:

• The improved access service.
• The paramedic led home visiting service.
• The nurse led home visiting service plus (a residential home visiting service).
• The wound care service.
• The Clinical Pharmacist Service.

From their head office at Fleet Health Centre, Vale Road, Northfleet, Gravesend, Kent, DA11 8BZ.

Opening times at Temple Hill Surgery (Improved Access Hub) are: Monday to Friday 1pm to 8pm.

Opening times at the other hub locations are:

• The Cedars Surgery (Improved Access Hub) – Tuesday and Wednesday 1pm to 8pm, as well as Saturday 10am to 4pm.
• Ivy Bower Surgery (Improved Access Hub) – Saturday 9am to 1pm.
• The Gateway Medical Practice – Monday to Friday 8.30am to 5.30pm (wound care service only).
• The Oaks Surgery (Improved Access Hub) – Monday 9am to 6.30pm. Wound care services are also offered here on Monday, Wednesday and Friday 8.30am to 5.30pm.
• White Horse Surgery (Improved Access Hub) – Monday to Saturday 9am to 8pm, as well as Sunday 9am to 2pm.

Some additional Improved access hub appointments are occasionally made available. GP practices are made aware in advance when this occurs.

The home visiting service and home visiting service plus are available from 8.30 am to 5,30pm and are booked by patients’ own GP practices.

The service does not have a website although some information regarding the improved access service is available on the host practices’ websites.

How we inspected this service

Prior to the inspection we contacted the commissioners of the service, NHS DGS CCG about the service. We also gathered and reviewed information and statutory notifications that CQC hold, and reviewed information that the providers sent to CQC.

During the inspection we observed the running of the services and spoke with board level directors, service leads, site managers and a range of staff employed by the service. We reviewed a range of provider documents and policies. We also reviewed feedback from patients as obtained from survey results and comment cards.

To get to the heart of patients’ experiences of care and treatment, we always ask the following five questions:

Is it safe?

Is it effective?

Is it caring?

Is it responsive?

Is it well-led?

These questions therefore formed the framework for the areas we looked at during the inspection.

Updated 29 April 2020

We carried out an announced comprehensive inspection at the Temple Hill Surgery (Improved Access Hub) as part of our inspection programme from 18 to 20 February 2020.

The service is provided by DGS Health Ltd, which delivers additional GP services to patients who are registered with GP practices within the NHS Dartford, Gravesham and Swanley Clinical Commissioning Group (CCG) area. The Temple Hill Surgery (Improved Access Hub) provides an improved access service only. The improved access service gives patients the choice of accessing GP services at a place that is not their own GP practice and at times when their own GP may or may not be open.

Other services run by DGS Health Ltd from their head office and other hubs include: a paramedic home visiting service; a home visiting service plus (to care homes); and a wound care service. DGS Health Ltd also employ and supervise Clinical Pharmacists who work at and support local GP practices.

DGS Health Ltd is operated from a head office based at the Fleet Health Campus, Fleet Health Centre, Vale Road, Northfleet, Gravesend, Kent, DA11 8BZ.

We saw examples of outstanding practice.

Supervision of staff was of a high quality. In particular the service had brought in an external clinician who was a senior clinical leader from the local NHS Trust Hospital to supervise and mentor the clinical leads for each of the additional services that DGS Health provided.

Our key findings were:

• The service had good systems to manage risk so that safety incidents were less likely to happen. When they did happen, the service learned from them and improved their processes.
• The service routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines.
• Staff involved and treated people with compassion, kindness, dignity and respect.
• Patients were able to access care and treatment from the service within an appropriate timescale for their needs.
• There was a strong focus on continuous learning, improvement and innovation at all levels of the organisation.

The areas where the provider should make improvements are:

• Create a service website.
• Continue to implement plans for audits of antimicrobial prescribing and other appropriate medicines audits.
• Senior management should consider increasing their visibility and accessibility to all staff and to reassure themselves that service level agreements were being met including the supply and checking of emergency medicines.
• Monitor that revised induction guidelines are being followed consistently across all hubs.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care